Nursing Grand Rounds Point of Care Scholars: Filling the Gaps in - PDF document

7/24/2014 Nursing Grand Rounds Point of Care Scholars: Filling the Gaps in Evidence with Research Christin Zwolski DPT, PT, OCS Deborah Williams RN, CNOR Jennifer Bekins MS, CCC-SLP Objective Discuss newly discovered gaps in nursing and allied health research evidence. The Importance of Evidence-Based Practice • Improves outcomes for children, families and our organization • Upholds Standards of Professional Practice • Supports core Magnet principles 1

7/24/2014 Organizational Outcomes • Safety • Care Integration • Community Health • Productivity • Cost • Clinical Expansion • Reach • Research • Innovation 2015 Strategic Plan Accelerating our way forward through improvement, innovation and partnerships Vision: Drive strategic & sustainable growth To be the leader in Decrease cost continuously improving child health Develop essential & transformative capabilities 5 National Patient Safety Goals • Hospital • Critical Access Hospital • Behavioral Health Care • Ambulatory Care • Home Care 2

7/24/2014 ����������������������� Standards of Practice Professional Organizations Magnet Model Components Magnet Model Component • New Knowledge, Innovations and Improvement 3

7/24/2014 Injury Prevention for Adolescent Female Soccer Players at Risk of Noncontact Anterior Cruciate Ligament Injury Christin Zwolski, PT, DPT, OCS Orthopedic and Sports Medicine Physical Therapy Objectives • To gain increased awareness of the need for injury prevention interventions in a population of young female soccer players at the highest risk of sustaining a noncontact anterior cruciate ligament (ACL) injury. • To explore and evaluate the current literature for evidence regarding injury prevention interventions • To discover the injury prevention efforts put forth by Cincinnati Children’s Medical Hospital Center’s Soccer Outreach Program Background • Why target young female soccer players? 4

7/24/2014 High Decreased High Risk Lack of Medical Quality of Intervention Population Costs Life Clinical Question P : Among adolescent female soccer players I : Does education alone C : vs. education plus high-risk screening and/or injury prevention training O : Decrease the number of noncontact ACL injuries? 5

7/24/2014 Search Strategy Keywords • Soccer, football, injury, prevention, education, adolescent, female, player, athlete, anterior cruciate ligament, knee Databases • PubMed, CINAHL, SPORTDiscus, PEDro • Date last search completed: 11/21/2013 Synthesis of the Evidence on ACL Injury Prevention • Efficacy: Mixed results • Best type, frequency, and delivery: Lack of consensus • None of the articles directly addressed the PICO question 6

7/24/2014 There is insufficient evidence and a lack of consensus to make a recommendation… Educational Intervention Implementation • Planned research study involving educational intervention in a population of adolescent female soccer players. • Aim 1 : To determine the extent of ACL injury prevention knowledge gained and retained from an educational intervention program among female adolescent soccer players aged 12-18. • Aim 2 : To investigate the effects of an educational intervention on the incidence of noncontact ACL injuries in female adolescent soccer players aged 12-18. 7

7/24/2014 Evaluation • Pre- and post-test assessments of injury prevention knowledge • Number of noncontact ACL injuries sustained following intervention In the meantime… Thank You! Christin Zwolski, PT, DPT, OCS Christin.zwolski@cchmc.org 8

7/24/2014 Reducing Sharps Injuries in the OR, Are We Using the Evidence? presented by: Deborah R. Williams RN II, CNOR Liberty Perioperative Services Objectives • To relate impact of Federal legislature known as the “Needlestick Safety and Prevention Act of 2000” on the reduction of sharps injuries • To explore evidence regarding reduction of sharps injuries in the operating room (OR) setting • To define top three recommended practices in reducing sharps injuries in the OR • To describe IRB proposal created to compare perforation rates when using single or double gloving technique Clinical Issue Federal legislature known as the Needlestick Safety and Prevention Act of 2000 brought about a drastic reduction of sharps injuries in the medical community overall, yet the incidence in the operating room actually saw an increase. The Needlestick Safety and Prevention Act of 2000 requires that annual review of exposure plans reflect changes in technology. It is important to keep our staff safe from blood borne pathogen exposure (BBPE) as well as our patients. CCHMC strategic safety goal supports this: We will achieve and maintain the lowest rates of hospital employee injury and reduce our current rate by no less than 50 percent by June 30, 2015. 9

7/24/2014 What prompted my interest in this topic? • Perioperative OSHA Recordables Committee, as part of its ongoing mission to reduce injuries in the OR setting, was responsible for organizing a meeting with an engineering group • I was invited to attend a safety device brainstorming session with this medical engineering group • As a Point of Care (POC) scholar, I created a PICO question to explore just what was in the literature regarding sharps safety PICO Question P Among OR personnel I does the use of sharps safety devices or interventions C versus none O reduce sharps injuries? Search Strategy • Keywords: sharps injuries, percutaneous injury, double gloving, neutral zone, blunt suture needles, engineered safety devices, operating room • Databases: Cochrane Database, Nursing Reference Center, PubMed, Google Scholar 10

7/24/2014 Findingss Six articles were found to be most relevant and appraised • 3 meta-analysis or systematic review(1a,1a,1b) • 1 qualitative studies (4b) • 1 cohort studies (4b) • 1published expert opinions (5a) • 3 published recommendation statements from professional perioperative organizations (5,5,5) Evidence Synthesis • OR personnel are at risk for blood-borne pathogen exposure (BBPE) due to sharps injuries and glove tears. • Surgeons and first assistants have the greatest risk of injury followed by scrub personnel • While engineered safety devices are encouraged, few have been found to be useful for use with suture needles and blades. • A Cochrane review and others support risk reduction through the use of double gloving and use of blunt suture needles. • Five of six articles supported the use of hands free technique (HFT), also known as the neutral zone. • One article was supportive of suturing adjuncts(devices for hands free loading) • Compliance with the utilization of recommended safety techniques is an issue ( lack of adherence) Grade for Body of Evidence Moderate grade was given for the following reasons: • Evidence directly relates to recommendation for this target population • Has significant benefit to target population as well as patient population • Has minimal adverse effects 11

7/24/2014 Most Common Recommendations in Literature • Neutral Zone also known as Hands Free Zone (HFT) • Double Gloving (use of indicator glove) • Use of blunt needles for muscle and fascia Neutral Zone or Hands Free Zone (HFT) • Neutral zone is a designated area where sharps can be placed to reduce the need for hand to hand passing of sharps • Three-quarters of sharps injuries occur during passing of devices • Most injuries are caused by suture needles • One study reported suture needles (43.4%) scalpel blades (17%) syringes (12%) Neutral Zone or Hands Free Zone (HFT) (continued) • Modified neutral zone- instrument with sharp passed to surgeon but returned to neutral zone • Reasons for non-compliance- we’ve always done it this way, need for surgeon to look away from field, microscopic cases 12

7/24/2014 Double Gloving Wearing an indicator glove(different color) under 2 nd pair of • gloves • Can reduce the risk of exposure to blood as much as 85% • Corresponding punctures of inner and outer glove rare • Volume of blood reduced as much as 95% when passing thru two glove layers • Barriers to adherence- complaint of lack of dexterity and hand sensitivity Use of Blunt Needles • Recommended for use on fascia and muscle • Significant reduction of glove perforations reported with use of blunt needles up to 54% • Perception that blunt needles more difficult to use • Alternative wound closure devices are recommended for skin whenever feasible (tissue adhesives, tissue staplers, adhesive skin closure strips, blunt needles) Use of Safety Scalpels / Engineered Safety Devices • Systematic Review/Meta-analysis of 72 citations reviewed, none were supportive of safety scalpels • Need to continue to explore better safety engineered devices (SED) 13

7/24/2014 Under-reporting of Sharps Injuries • It is reported that 70%-96% of percutaneous injuries in perioperative personnel are under- reported. • Don’t want to take the time to go through the post exposure procedures • Perception that patient population is low risk Recommendation The use of safety devices and/or interventions are recommended to reduce sharps injuries among OR personnel. Institutional Review Board (IRB) Proposal A Comparison Study: Does Double Gloving Afford More Protection from Glove Perforations than Single Gloving, Among Operating Room (OR) Personnel? 14